Statins (HMG-CoA Reductase Inhibitors) are the mainstay treatment elevated serum LDL cholesterol.
Common side effects (5% to 10% of patients) : gastrointestinal upset and myalgia.
Patients at risk for myalgia: old age, renal impairment, obesity, and interaction with other drugs.
Make sure that the patient is not on:
fibrates, itraconazole, ketoconazole, cyclosporin , nefazodone, erythromycin, and clarithromycin.
Warn patients that consuming large quantities of grapefruit juice may increase the risk of myositis.
Patients on simvastatin may have increased levels of Warfarin, amiodarone and digoxin.
Statins are contraindicated during pregnancy or lactation.
During follow up:
Check serum Creatine Kinase (CK) at baseline, and after initiation of treatment if the patient complains of myalgia.
Discontinue if CK is more than 10 times the upper limit of normal. (less severe elevation is acceptable, though should be carefully monitored).
Check liver enzymes before and after initiation of therapy (shouldn't exceed 3 times the upper limit of normal).
Check serum lipids (if the indication is dyslipidemia), regularly until normalized, then once per year.